BackgroundA noninvasive and reliable approach to quantitatively measure muscle perfusion of lower extremity is needed to aid the diagnosis and treatment of peripheral artery disease (PAD).PurposeTo verify the reproductivity of using blood oxygen level‐dependent (BOLD) imaging to evaluate perfusion in lower extremities, and explore its correlation with walking performance in patients with PAD.Study TypeProspective observational study.SubjectsSeventeen patients with lower extremity PAD (mean age: 67 ± 6 years, 15 males) and eight older adults (controls).Field Strength/SequenceDynamic multi‐echo gradient echo T2* weighted imaging at 3T.AssessmentPerfusion was analyzed in regions of interest according to muscle groups. Perfusion parameters were measured, such as minimum ischemia value (MIV), time to peak (TTP), and gradient during reactive hyperemia (Grad) by two independent users. Walking performance experiments including short physical performance battery (SPPB) and 6‐minute walk were tested in patients.Statistical TestsBOLD parameters were compared using Mann–Whitney U test and Kruskal–Wallis test. Relations between parameters and walking performance were assessed by Mann–Whitney U test and Spearman's correlation coefficient.ResultsGood to perfect agreement was demonstrated for all perfusion parameters of interuser reproducibility, and the interscan reproducibility of MIV, TTP, and Grad was good. The TTP of the patients was longer than that of the controls (87.85 ± 38.85 s vs. 36.54 ± 7.27 s), while the Grad of patients was smaller (0.16 ± 0.12 msec/s vs. 0.24 ± 0.11 msec/s). Among PAD patients, the MIV was significantly lower in the low SPPB subgroup (score 6–8) than in the high SPPB group (score 9–12), and the TTP was negatively correlated with 6‐minute walk distance (ρ = −0.549).Data ConclusionBOLD imaging method had overall good reproducibility for the perfusion assessment of calf muscles. The perfusion parameters were different between PAD patients and controls, and were correlated with lower extremity function.Evidence Level2Technical EfficacyStage 2